Resolution of gestational gigantomastia with termination of pregnancy

Less than 100 cases of gestational gigantomastia have been described in literature. The aetiology and risk factors are not well-established. Various treatments have been used with some consensus. We present the case of a 47-year-old female who presented to us with bilateral gigantomastia in her 16th week of gestation. She had massively enlarged breasts which were very painful. Relevant laboratory investigations were normal. An incisional biopsy done prior to, and two trucut samples at presentation to us, showed normal breast tissue proliferation. In the absence of adequate pain control, it was decided to electively terminate the pregnancy and give a trial of tamoxifen. She made a rapid recovery following termination without requiring the use of tamoxifen

Revolutionizing Medical Education Through Digital Technologies

Digital technologies are electronic tools, systems, processes, devices, and resources that generate, store, or process data. Common examples are websites, video streaming, e- books, blogs, virtual patients, social media platforms (Facebook, Twitter, and Instagram), tools (personal computers, smart phones, tablets) and education-specific devices (data projectors, multimedia, simulators, digital cameras, digital stethoscopes, and laparoscopic simulators). As a matter of fact, it is critical for medical educationists to have a basic understanding of these dependencies to make the best use of these technologies in their teaching. A wide range of available digital technologies support today's medical teaching, including content, tools, devices, systems, and processes, all of which are mutually dependent, and in turn, all rely on infrastructure. Furthermore, it is important to choose and use appropriate digital tools and processes that best meet their needs..........................................

THE BREAST MOUSE: AN OBSERVATIONAL STUDY OF BREAST FIBROADENOMAS IN THE PAKISTANI POPULATION

OBJECTIVE: To assess the characteristics of fibroadenomas and demographics of women presenting with breast masses in order to differentiate such masses from malignant breast masses. METHODS:  This cross-sectional survey was conducted at Khyber Teaching Hospital, Pakistan. Women with breast masses presenting to surgical outpatient department were assessed by taking a thorough history and breast examination, followed by imaging (ultrasound/mammography). Diagnosis was confirmed by fine needle aspiration cytology/Core biopsy. Only diagnosed cases of fibroadenomas were included in this study. RESULTS: Majority (n=93; 70.5%) of fibroadenoma patients were aging from 16-30 years. Seventy (n=70; 53.0%) patients belonged to urban areas. Menstrual cycle was regular in 123 (93.2%) cases. Sixty-four (48.5%) patients were using oral contraceptive pills. Majority (n=79; 59.8%) of patients were nulliparous.  Most (38.6%) women presented with a duration of the lump in 1-6 months. Approximately half (n=51; 53 %) of patient reported no increase in size. Lump was painful in 77 (58.3%) cases and 34 (74.2%) stated that the pain was acyclical. Lumps were mainly located on left side (n=64; 48.5%) and in upper outer quadrants (n=54; 40.9%) of breast. Mean lump size was 4.05 cm. Only 9 (6.8%) patients reported nipple discharge. Almost all of the patients (n=128; 97%) chose to undergo excision of the fibroadenoma. CONCLUSION: Fibroadenomas are a common presentation in women presenting with breast masses in the surgical outpatient department, most frequent in women aging 16-30 years and nulliparous. There is a strong predominance in the left breast in the upper outer quadrant

Preliminary insights on the mutational spectrum of BRCA1 and BRCA2 genes in Pakhtun ethnicity breast cancer patients from Khyber Pakhtunkhwa (KP), Pakistan

Gene mutations are a source of genetic instability which fuels the progression of cancer. Mutations in BRCA1 and BRCA2 are considered as major drivers in the progression of breast cancer and their detection indispensable for devising therapeutic and management approaches. The current study aims to identify novel pathogenic and recurrent mutations in BRCA1 and BRCA2 in Pakhtun population from the Khyber Pakhtunkhwa. To determine the BRCA1 and BRCA2 pathogenic mutation prevalence in Pakhtun population from KP, whole exome sequencing of 19 patients along with 6 normal FFPE embedded blocks were performed. The pathogenicity of the mutations were determined and they were further correlated with different hormonal, sociogenetic and clinicopathological features. We obtained a total of 10 mutations (5 somatic and 5 germline) in BRCA1 while 27 mutations (24 somatic and 3 germline) for BRCA2. Five and seventeen pathogenic or deleterious mutations were identified in BRCA1 and BRCA2 respectively by examining the mutational spectrum through SIFT, PolyPhen-2 and Mutation Taster. Among the SNVs, BRCA1 p.P824L, BRCA2 p. P153Q, p.I180F, p.D559Y, p.G1529R, p.L1576F, p.E2229K were identified as mutations of the interaction sites as predicted by the deep algorithm based ISPRED-SEQ prediction tool. SAAFEQ-SEQ web-based algorithm was used to calculate the changes in free energy and effect of SNVs on protein stability. All SNVs were found to have a destabilizing effect on the protein. ConSurf database was used to determine the evolutionary conservation scores and nature of the mutated residues. Gromacs 4.5 was used for the molecular simulations. Ramachandran plots were generated using procheck server. STRING and GeneMania was used for prediction of the gene interactions. The highest number of mutations (BRCA1 7/10, 70 %) were on exon 9 and (BRCA2, 11/27; 40 %) were on exon 11. 40 % and 60 % of the BRCA2 mutations were associated Grade 2 and Grade 3 tumors respectively. The present study reveals unique BRCA1 and BRCA2 mutations in Pakhtun population. We further suggest sequencing of the large cohorts for further characterizing the pathogenic mutations

Effect of Plant Growth Hormones on Shoot and Root Regeneration in Rose under In Vitro Conditions

Background: Rose is a commercially important shrub. This research aimed to observe the influence of different plant growth hormones on development of shoots and roots of Rosa Indica L. in tissue culture.Methods: Various concentrations of N6-Benzylaminopurine (BAP), 1-Naphthaleneacetic acid (NAA), Indole-3-acetic acid (IAA), and Indole-3-butyric acid (IBA) were used in the study. The different concentrations of BAP (2.00, 3.00, and 4.00 mg l-1) and IAA (2.00 and 3.00 mg l-1) were tested for shoot induction. While varying concentrations of IAA and IBA were analyzed for root proliferation.Results: The results of the study indicated that the fastest shoot initiation (17.77 days), the highest number of shoots bottle-1 (3.55), the maximum shoot length (4.72 cm), and the utmost number of leaves bottle-1 (53.67) were observed on MS media containing 3.00 mg l-1 BAP, 3.00 mg l-1 IAA, and 30 g l-1 sugar, while the highest number of shoots bottle-1 were produced under MS + 2.00 mg l-1 BAP + 3.00 mg l-1 IAA + 30 g l-1 sugar. Regarding root induction, the maximum number of roots (4.67) and root length (2.60 cm) were observed under half strength MS media supplemented with 30 g l-1 sugar.Conclusion: The study suggested that MS media containing 3.00 mg l-1 BAP and IAA could be used for tissue culturing rose plants. For root induction, half-strength MS media, along with sugar, could be used. The study gives an insight into potential media compositions for the propagation of rose. The suggested media can have promising uses in commercial multiplication of this important plant.Keywords: Rose; Tissue culture; Micropropagation; MS media; Shoot developmen

SCNN-Attack: A Side-Channel Attack to Identify YouTube Videos in a VPN and Non-VPN Network Traffic

Encryption Protocols e.g., HTTPS is utilized to secure the traffic between servers and clients for YouTube and other video streaming services, and to further secure the communication, VPNs are used. However, these protocols are not sufficient to hide the identity of the videos from someone who can sniff the network traffic. The present work explores the methodologies and features to identify the videos in a VPN and non-VPN network traffic. To identify such videos, a side-channel attack using a Sequential Convolution Neural Network is proposed. The results demonstrate that a sequence of bytes per second from even one-minute sniffing of network traffic is sufficient to predict the video with high accuracy. The accuracy is increased to 90% accuracy in the non-VPN, 66% accuracy in the VPN, and 77% in the mixed VPN and non-VPN traffic, for models with two-minute sniffing

Robotic-Assisted Surgery for Benign Urological Conditions

Robotic technology for use in surgery has advanced considerably in the past 10 years. This has become particularly apparent in urology where robotic-assisted radical prostatectomy using the da VinciTM surgical system (Intuitive Surgical, CA) has become very popular. The use of robotic assistance for benign urological procedures is less well documented. This article considers the current robotic technology and reviews the situation with regard to robotic surgery for benign urological conditions

E-Ensemble: A Novel Ensemble Classifier for Encrypted Video Identification

In recent years, video identification within encrypted network traffic has gained popularity for many reasons. For example, a government may want to track what content is being watched by its citizens, or businesses may want to block certain content for productivity. Many such reasons advocate for the need to track users on the internet. However, with the introduction of the secure socket layer (SSL) and transport layer security (TLS), it has become difficult to analyze traffic. In addition, dynamic adaptive streaming over HTTP (DASH), which creates abnormalities due to the variable-bitrate (VBR) encoding, makes it difficult for researchers to identify videos in internet traffic. The default quality settings in browsers automatically adjust the quality of streaming videos depending on the network load. These auto-quality settings also increase the challenge in video detection. This paper presents a novel ensemble classifier, E-Ensemble, which overcomes the abnormalities in video identification in encrypted network traffic. To achieve this, three different classifiers are combined by using two different combinations of classifiers: the hard-level and soft-level combinations. To verify the performance of the proposed classifier, the classifiers were trained on a video dataset collected over one month and tested on a separate video dataset captured over 20 days at a different date and time. The soft-level combination of classifiers showed more stable results in handling abnormalities in the dataset than those of the hard-level combination. Furthermore, the soft-level classifier combination technique outperformed the hard-level combination with a high accuracy of 81.81%, even in the auto-quality mode

Alarming prevalence of Candida auris among critically ill patients in intensive care units in Dhaka City, Bangladesh

Background: Candida auris is a multidrug-resistant yeast capable of invasive infection with high mortality and healthcare-associated outbreaks globally. Due to limited labratory capacity, the burden of C. auris is unknown in Bangladesh. We estimated the extent of C. auris colonization and infection among patients in Dhaka city intensive care units. Methods: During August 2021–September 2022 at adult intensive care units (ICUs) and neonatal intensive care units (NICUs) of 1 government and 1 private tertiary-care hospital, we collected skin swabs from all patients and blood samples from sepsis patients on admission, mid-way through, and at the end of ICU or NICU stays. Skin swab and blood with growth in blood-culture bottle were inoculated in CHROMagar, and identification of isolates was confirmed by VITEK-2. Patient characteristics and healthcare history were collected. We performed descriptive analyses, stratifying by specimen and ICU type. Results: Of 740 patients enrolled, 59 (8%) were colonized with C. auris, of whom 2 (0.3%) later developed a bloodstream infection (BSI). Among patients colonized with C. auris, 27 (46%) were identified in the ICU and 32 (54%) were identified from the NICU. The median age was 55 years for C. auris–positive ICU patients and 4 days for those in the NICU. Also, 60% of all C. auris patients were male. Among 366 ICU patients, 15 (4%) were positive on admission and 12 (3%) became colonized during their ICU stay. Among 374 NICU patients, 19 (5%) were colonized on admission and 13 (4%) became colonized during their NICU stay. All units identified C. auris patients on admission and those who acquired it during their ICU or NICU stay, but some differences were observed among hospitals and ICUs (Figure). Among patients colonized on admission to the ICU, 11 (73%) were admitted from another ward, 3 (20%) were admitted from another hospital, and 1 (7%) were admitted from home. Of patients colonized on admission to the NICU, 4 (21%) were admitted from the obstetric ward, 9 (47%) were admitted from another hospital, and 6 (32%) were admitted from home. In addition, 18 patients with C. auris died (12 in the ICU and 6 in the NICU); both patients with C. auris BSIs died. Conclusions: In these Bangladesh hospitals, 8% of ICU or NICU patients were positive for C. auris, including on admission and acquired during their ICU or NICU stay. This high C. auris prevalence emphasizes the need to enhance case detection and strengthen infection prevention and control. Factors contributing to C. auris colonization should be investigated to inform and strengthen prevention and control strategies

Deterministic evolution and stringent selection during preneoplasia

The earliest events during human tumour initiation, although poorly characterized, may hold clues to malignancy detection and prevention1. Here we model occult preneoplasia by biallelic inactivation of TP53, a common early event in gastric cancer, in human gastric organoids. Causal relationships between this initiating genetic lesion and resulting phenotypes were established using experimental evolution in multiple clonally derived cultures over 2 years. TP53 loss elicited progressive aneuploidy, including copy number alterations and structural variants prevalent in gastric cancers, with evident preferred orders. Longitudinal single-cell sequencing of TP53-deficient gastric organoids similarly indicates progression towards malignant transcriptional programmes. Moreover, high-throughput lineage tracing with expressed cellular barcodes demonstrates reproducible dynamics whereby initially rare subclones with shared transcriptional programmes repeatedly attain clonal dominance. This powerful platform for experimental evolution exposes stringent selection, clonal interference and a marked degree of phenotypic convergence in premalignant epithelial organoids. These data imply predictability in the earliest stages of tumorigenesis and show evolutionary constraints and barriers to malignant transformation, with implications for earlier detection and interception of aggressive, genome-instable tumours